Method and device for ameliorating joint conditions and diseases

ABSTRACT

A device for ameliorating joint conditions and diseases comprising a) a first section comprising a joint-ward end, an opposing mating end, and a lateral wall, a peripheral column partially forming the lateral wall of the first section, a central column, and three or more than three struts extending between and connecting the peripheral column and the central column, and each strut thereby supporting the central column, the joint-ward end further comprising a plurality of fenestrations formed by a confluence of the peripheral column, the central column and two adjacent struts of the three or more than three struts, and first section further comprising a central aperture within and formed by the central column, and configured to mate with a driver, b) a second section comprising a mating end, an opposing leading end, and a lateral wall, the lateral wall of the second section comprising threads.

CROSS-REFERENCE TO RELATED APPLICATION

This present Application is a continuation-in-part of U.S. patentapplication Ser. No. 12/328,493, titled “Joint Support and SubchondralSupport System,” filed Dec. 4, 2008, the contents of which areincorporated in this disclosure by reference in their entirety.

BACKGROUND

There are a variety of conditions and diseases that impair the integrityand function of human joints. Among these joint conditions and diseasesare arthroses, chondromalacia patella, isolated chondral defect,juvenile idiopathic arthritis, ligamentous deficiency arthroses,osteoarthritis (degenerative arthritis or degenerative joint disease),osteonecrosis, osteochondritis dissecans, patellar instability,post-ligamentous injury arthritis, post-meniscectomy arthritis,post-meniscectomy arthroses, post-traumatic arthritis, rheumatoidarthritis and septic arthritis. The incidence of arthritides alone inthe United States exceeds 20%, with higher rates among women as comparedto men. Treatment of joint conditions and diseases includes surgery andthe administration of therapeutic agents. However, none of thesetreatments ameliorate all of the joint conditions and diseases.

Therefore, there is a need for a new method for ameliorating jointconditions and diseases.

SUMMARY

According to one embodiment of the present invention, there is provideda device for ameliorating joint conditions and diseases. The devicecomprises a) a first section comprising a joint-ward end, an opposingmating end, and a lateral wall extending between the joint-ward end andthe mating end, where the first section further comprises a peripheralcolumn partially forming the lateral wall of the first section, acentral column, and three or more than three struts, each strutextending between and connecting the peripheral column and the centralcolumn, and each strut thereby supporting the central column, where thejoint-ward end further comprises a plurality of fenestrations, whereeach fenestration is formed by a confluence of the peripheral column,the central column and two adjacent struts of the three or more thanthree struts, and where the first section further comprises a centralaperture within and formed by the central column, and configured to matewith a driver, b) a second section comprising a mating end, an opposingleading end, and a lateral wall extending between the mating end and theleading end, where the lateral wall of the second section comprisesthreads.

In one embodiment, the device further comprises an axial length, and theaxial length is between 5 mm and 30 mm. In another embodiment, thedevice further comprises an axial length, and the axial length isbetween 5 mm and 20 mm. In another embodiment, the device furthercomprises an axial length, and the axial length is between 8 mm and 16mm. In one embodiment, the first section further comprises a diameterbetween 5 mm and 30 mm. In another embodiment, the first section furthercomprises a diameter between 5 mm and 20 mm. In another embodiment, thefirst section further comprises a diameter between 8 mm and 16 mm. Inanother embodiment, the first section further comprises an axial lengthbetween 1 mm and 2 mm.

In one embodiment, each fenestration comprises a pear or teardrop shape.In another embodiment, one or more than one fenestration comprises adifferent size, different shape or both a different size and a differentshape than one or more than one other fenestration.

In one embodiment, the central aperture comprises a six-pointed starshape. In another embodiment, the central aperture is round andcomprises threads. In one embodiment, the peripheral column comprisesone or more than one notch.

In one embodiment, the joint-ward end comprises a convex profile as seenon a cross-sectional, lateral perspective view. In another embodiment,the joint-ward end comprises a concave profile as seen on across-sectional, lateral perspective view. In another embodiment, thejoint-ward end comprises a straight profile as seen on across-sectional, lateral perspective view. In one embodiment, thejoint-ward end comprises a radius of curvature of between 20 mm and 50mm. In another embodiment, the joint-ward end comprises a radius ofcurvature of between 15 mm and 45 mm. In another embodiment, the lateralwall of the first section comprises a generally convex profile as seenon a cross-sectional, lateral perspective view.

In one embodiment, the second section further comprises an axial lengthbetween 5 mm and 30 mm. In another embodiment, the second sectionfurther comprises an axial length between 5 mm and 20 mm. In anotherembodiment, the second section further comprises an axial length between6 mm and 15 mm. In one embodiment, the lateral wall of the secondsection is generally cylindrical. In another embodiment, the lateralwall of the second section is generally conical, tapering between themating end and the leading end. In one embodiment, the lateral wall ofthe second section tapers between 0.2 degrees and 15 degrees. In anotherembodiment, the lateral wall of the second section tapers between 1degrees and 5 degrees. In another embodiment, the lateral wall of thesecond section tapers between 1 degrees and 3 degrees.

In one embodiment, the mating end of the first section and the matingend of the second section mate by a biocompatible adhesive. In anotherembodiment, the mating end of the first section and the mating end ofthe second section mate by a mating mechanism that is reversible. Inanother embodiment, the mating end of the first section and the matingend of the second section mate by a reversible twist locking mechanism.In another embodiment, the first section and the second section are madeas a unified whole.

In one embodiment, the leading end comprises a scalloped edge. Inanother embodiment, the leading end comprises bevels. In anotherembodiment, the leading end comprises both a scalloped edge and bevels.

In one embodiment, the lateral wall of the second section furthercomprises a plurality of fenestrations between the threads. In anotherembodiment, the device further comprises a plurality of fenestrationsformed by a confluence of the mating end of the first section and themating end of the second section. In one embodiment, the device furthercomprises an insert, where the insert comprises a base and three or morethan three extensions connected to the base and arranged radially aroundthe base, and where each of the three or more than three extensions isconfigured to fit within a corresponding fenestration of the joint-wardend of first section of the device. In one embodiment, the insertfurther comprises porous biological material impregnated withmatrix-promoting substances or serves as a scaffold for progenitorcells, or comprises both porous biological material impregnated withmatrix-promoting substances and serves as a scaffold for progenitorcells.

According to another embodiment of the present invention, there isprovided a method for ameliorating a joint condition or disease in apatient. The method comprises a) identifying a patient with a jointcondition or disease that is suitable for treatment by the method, wherethe joint comprises a bone with a surface comprising a defect caused bythe joint condition or disease, b) accessing the joint, c) placing aguidepin within the center of the defect, d) creating a space in thedefect of the bone, e) providing a first device according to the presentinvention, f) attaching the first device to a driver by mating thedistal end of the driver with the central aperture of the first device,and g) screwing the first device into the space using the driver untilthe joint-ward end of the first device forms a shape that substantiallyrecreates the shape of a normal articulation surface on the bone afterimplantation.

In one embodiment, the joint is a diarthrodial joint. In anotherembodiment, the joint is selected from the group consisting of anacetabulofemoral joint, an acromioclavicular joint, a femoropatellarjoint, a femorotibial joint, a glenohumeral joint, a humeroradial joint,a humeroulnar joint, an interphalangeal joint, a metacarpal joint, aradioulnar joint and a talocrural joint. In one embodiment, the patientis a human. In one embodiment, the patient is a non-human animal. In oneembodiment, the joint condition and disease is selected from the groupconsisting of arthroses, chondromalacia patella, isolated chondraldefect, juvenile idiopathic arthritis, ligamentous deficiency arthroses,osteoarthritis (degenerative arthritis or degenerative joint disease),osteonecrosis, osteochondritis dissecans, patellar instability,post-ligamentous injury arthritis, post-meniscectomy arthritis,post-meniscectomy arthroses, post-traumatic arthritis, rheumatoidarthritis and septic arthritis.

In one embodiment, identifying the patient comprises diagnosing thepatient with a joint condition and disease. In another embodiment,diagnosing the patient comprises performing one or more than one ofaction selected from the group consisting of performing a physicalexamination, performing a non-invasive imaging examination andperforming arthroscopy. In one embodiment, identifying the patientcomprises consulting patient records to determine if the patient has ajoint condition or disease suitable for treatment by the method. In oneembodiment, accessing the joint is accomplished by arthroscopy. In oneembodiment, the joint is accomplished by an open surgical procedure.

In one embodiment, the surface of the bone comprises one or more thanone abnormality, and the method further comprises using a burr, or asuction shaver, or both a burr and a suction shaver to remove some orall of the one or more than one abnormality thereby creating a smootherarticulation surface. In one embodiment, the method further comprisescreating one or more than one vascular channel in the bone deep to thespace using a drill bit guide positioned over the guidepin and a drillbit passed within the drill bit guide. In another embodiment, the methodfurther comprises injecting a biological material into the first device.In one embodiment, the method further comprises placing an insert in thefirst device. In one embodiment, the method further comprises placingone or more than one additional device in the defect.

DRAWINGS

These and other features, aspects and advantages of the presentinvention will become better understood with regard to the followingdescription, appended claims, and accompanying figures where:

FIG. 1 is a lateral perspective view of one embodiment of a device forameliorating joint conditions and diseases according to the presentinvention;

FIG. 2 is a top, lateral perspective view of another embodiment of adevice for ameliorating joint conditions and diseases according to thepresent invention;

FIG. 3 is an exploded, top, lateral perspective view of the embodimentof the device for ameliorating joint conditions and diseases shown inFIG. 1;

FIG. 4 is a top perspective view of the embodiment of the device forameliorating joint conditions and diseases shown in FIG. 1;

FIG. 5 is a bottom perspective view of the embodiment of the device forameliorating joint conditions and diseases shown in FIG. 1;

FIG. 6 is a top perspective view of the embodiment of the device forameliorating joint conditions and diseases shown in FIG. 2;

FIG. 7 is a top perspective view of another embodiment of the device forameliorating joint conditions and diseases according to the presentinvention;

FIG. 8 is a top perspective view of another embodiment of the device forameliorating joint conditions and diseases according to the presentinvention;

FIG. 9 is a cross-sectional, lateral perspective view of the embodimentof the device for ameliorating joint conditions and diseases shown inFIG. 1 taken along line 9-9;

FIG. 10 is a cross-sectional, lateral perspective view of anotherembodiment of the device for ameliorating joint conditions and diseasesaccording to the present invention;

FIG. 11 is a cross-sectional, lateral perspective view of the embodimentof the device for ameliorating joint conditions and diseases shown inFIG. 2 taken along line 11-11;

FIG. 12 is a top, lateral perspective view of one embodiment of aninsert according to the present invention for use with a device forameliorating joint conditions and diseases according to the presentinvention;

FIG. 13 is a bottom, lateral perspective view of the embodiment of theinsert shown in FIG. 12;

FIG. 14 is a top, lateral perspective view of one embodiment of thedevice for ameliorating joint conditions and diseases shown in FIG. 1with the insert shown in FIG. 12 according to the present inventionaffixed to the device;

FIG. 15 is a cross-sectional view of the device for ameliorating jointconditions and diseases shown in FIG. 1 with the insert shown in FIG. 12according to the present invention affixed to the device; and

FIG. 16 through FIG. 35 are schematic depictions of some steps of amethod for ameliorating joint conditions and diseases according to thepresent invention.

DESCRIPTION

According to one embodiment of the present invention, there is provideda device for ameliorating joint conditions and diseases. According toanother embodiment of the present invention, there is provided a methodfor ameliorating a joint condition or disease in a patient. In oneembodiment, the method comprises providing a device according to thepresent invention. The device and methods will now be disclosed indetail.

As used in this disclosure, except where the context requires otherwise,the term “comprise” and variations of the term, such as “comprising,”“comprises” and “comprised” are not intended to exclude other additives,components, integers or steps.

As used in this disclosure, except where the context requires otherwise,the method steps disclosed and shown are not intended to be limiting norare they intended to indicate that each step is essential to the methodor that each step must occur in the order disclosed but instead areexemplary steps only.

All dimensions specified in this disclosure are by way of example onlyand are not intended to be limiting, except where the context requiresotherwise. Further, the proportions shown in these Figures are notnecessarily to scale. As will be understood by those with skill in theart with reference to this disclosure, the actual dimensions andproportions of any device or part of a device disclosed in thisdisclosure will be determined by its intended use.

According to one embodiment of the present invention, there is provideda device for ameliorating joint conditions and diseases. Referring nowto FIG. 1 through FIG. 11, there are shown, respectively, a lateralperspective view of one embodiment of a device for ameliorating jointconditions and diseases according to the present invention (FIG. 1); atop, lateral perspective view of another embodiment of a device forameliorating joint conditions and diseases according to the presentinvention (FIG. 2); an exploded, top, lateral perspective view of theembodiment of the device for ameliorating joint conditions and diseasesshown in FIG. 1 (FIG. 3); a top perspective view of the embodiment ofthe device for ameliorating joint conditions and diseases shown in FIG.1 (FIG. 4); a bottom perspective view of the embodiment of the devicefor ameliorating joint conditions and diseases shown in FIG. 1 (FIG. 5);a top perspective view of the embodiment of the device for amelioratingjoint conditions and diseases shown in FIG. 2 (FIG. 6); a topperspective view of another embodiment of the device for amelioratingjoint conditions and diseases according to the present invention (FIG.7); a top perspective view of another embodiment of the device forameliorating joint conditions and diseases according to the presentinvention (FIG. 8); a cross-sectional, lateral perspective view of theembodiment of the device for ameliorating joint conditions and diseasesshown in FIG. 1 taken along line 9-9 (FIG. 9); a cross-sectional,lateral perspective view of another embodiment of the device forameliorating joint conditions and diseases according to the presentinvention (FIG. 10); and a cross-sectional, lateral perspective view ofthe embodiment of the device for ameliorating joint conditions anddiseases shown in FIG. 2 taken along line 11-11 (FIG. 11). As can beseen, the device 10 comprises a first section 12 and a second section14, and comprises a generally cylindrical shape partially or completelyclosed at one end. The device 10 further comprises an axial length(a-a). In one embodiment, the axial length (a-a) is between 5 mm and 30mm. In another embodiment, the axial length (a-a) is between 5 mm and 20mm. In another embodiment, the axial length (a-a) is between 8 mm and 16mm. In a preferred embodiment, the axial length (a-a) is 8 mm. Inanother preferred embodiment, the axial length (a-a) is 12 mm. Inanother preferred embodiment, the axial length (a-a) is 16 mm.

The first section 12 of the device 10 comprises a joint-ward end 16, anopposing mating end 18, and a lateral wall 20 extending between thejoint-ward end 16 and the mating end 18. The first section 12 furthercomprises a diameter (d-d) and an axial length (b-b). In one embodiment,the diameter (d-d) is between 5 mm and 30 mm. In another embodiment, thediameter (d-d) is between 5 mm and 20 mm. In another embodiment, thediameter (d-d) is between 8 mm and 16 mm. In a preferred embodiment, thediameter (d-d) is 8 mm. In another preferred embodiment, the diameter(d-d) is 12 mm. In another preferred embodiment, the diameter (d-d) is16 mm. In one embodiment, the axial length (b-b) is between 0.5 mm and2.5 mm. In another embodiment, the axial length (b-b) is between 1 mmand 2 mm. In a preferred embodiment, the axial length (b-b) is 1.25 mm.

In one embodiment, the first section 12 further comprises a peripheralcolumn 22 partially forming the lateral wall 20, a central column 24,and three or more than three struts 26, each strut 26 extending betweenand connecting the peripheral column 22 and the central column 24, andeach strut 26 thereby supporting the central column 24.

In one embodiment, the joint-ward end 16 further comprises a pluralityof fenestrations 28, where each fenestration 28 is formed by aconfluence of the peripheral column 22, the central column 24, and twoadjacent struts 26 of the three or more than three struts 26. Eachfenestration 28 can comprise any shape suitable for the intended purposeof the device 10, as will be understood by those with skill in the artwith respect to this disclosure. In one embodiment, as shownparticularly in FIG. 2, FIG. 3, FIG. 4, FIG. 5, FIG. 6 and FIG. 7, eachfenestration 28 comprises a pear or teardrop shape. In anotherembodiment, as shown in FIG. 8, each fenestration 28 comprises a kidneyshape. In another embodiment, each fenestration 28 comprises an oval ora round shape. As will be understood by those with skill in the art withrespect to this disclosure, all fenestrations 28 on the device 10 cancomprise the same size and shape or one or more than one fenestration 28can comprise a different size, different shape or both a different sizeand a different shape than one or more than one other fenestration 28.In another embodiment, the joint-ward end 16 can be solid between thecentral column 24 and the peripheral column 22.

The first section 12 further comprises a central aperture 30 within andformed by the central column 24. The central aperture 30 can extendaxially completely through the joint-ward end 16 as shown particularlyin FIG. 9, FIG. 10 and FIG. 11, or can be blind-ended extending onlypartially through within joint-ward end 16. The central aperture 30 isconfigured to mate with a driver as disclosed below. The centralaperture 30 comprises any shape suitable for the intended purpose of thedevice 10, as will be understood by those with skill in the art withrespect to this disclosure. In one embodiment, the central aperture 30comprises a square shape. In one embodiment, as shown in FIG. 2 and FIG.6, the central aperture 30 comprises a round shape. In anotherembodiment, as shown in FIG. 3, FIG. 4 and FIG. 5, the central aperture30 comprises a six-pointed star shape. In another embodiment, as shownin FIG. 7, the central aperture 30 comprises a pentagonal shape. Inanother embodiment, as shown in FIG. 8, the central aperture 30comprises a hexagonal shape. In one embodiment, as shown in FIG. 2 andFIG. 11, the central aperture 30 comprises threads 32 to assist inmating with a driver.

In one embodiment, peripheral column 22 of the first section 12comprises one or more than one notch 34 as seen in FIG. 2, FIG. 6 andFIG. 11. The one or more than one notch can be used to mate with adriver in addition to the central aperture 30 or instead of the centralaperture 30, as will be understood by those with skill in the art withrespect to this disclosure.

The joint-ward end 16 of the first section 12 of the device 10 performsa partial load-bearing function after implantation, and comprises ashape suitable to substantially match the shape of the articulationsurface that the device 10 recreates on the bone after implantation, aswill be understood by those with skill in the art with respect to thisdisclosure. Therefore, the joint-ward end 16 can have either a convexprofile as seen on a cross-sectional, lateral perspective view, as shownin FIG. 9 and FIG. 11, a concave profile as seen on a cross-sectional,lateral perspective view, as shown in FIG. 10, or a straight profile asseen on a cross-sectional, lateral perspective view. In one embodiment,the joint-ward end has a convex profile having a radius of curvature ofbetween 10 mm and 50 mm. In another embodiment, the joint-ward end has aconvex profile as seen on a cross-sectional, lateral perspective viewwith a radius of curvature of between 15 mm and 45 mm. In anotherembodiment, the joint-ward end has a convex profile as seen on across-sectional, lateral perspective view with a radius of curvature ofbetween 20 mm and 30 mm. In one embodiment, the joint-ward end has aconcave profile as seen on cross-sectional, lateral perspective viewwith a radius of curvature of between 10 mm and 50 mm. In anotherembodiment, the joint-ward end has a concave profile as seen oncross-sectional, lateral perspective view with a radius of curvature ofbetween 15 mm and 45 mm. In another embodiment, the joint-ward end has aconcave profile as seen on cross-sectional, lateral perspective viewwith a radius of curvature of between 20 mm and 30 mm. In a preferredembodiment, the joint-ward end 16 comprises a smooth surface facing thecenter of joint after implantation, as will be understood by those withskill in the art with respect to this disclosure. In a preferredembodiment, the joint-ward end 16 is polished to make the surfacesmooth.

The lateral wall 20 of the first section 12 can be any shape suitablefor the intended purpose of the device 10, as will be understood bythose with skill in the art with respect to this disclosure. In apreferred embodiment, the lateral wall 20 of the first section 12comprises a generally convex profile as seen on a cross-sectional,lateral perspective view, as shown in FIG. 9 and FIG. 11. This convexprofile advantageously provides a smooth transition to and encouragesbiologic bonding to surrounding cartilage and bone after implantation,as will be understood by those with skill in the art with respect tothis disclosure.

The device 10 further comprises a second section 14. The second section14 of the device 10 comprises a mating end 36, an opposing leading end38, and a lateral wall 40 extending between the mating end 36 and theleading end 38. The second section 14 further comprises an axial length(c-c). In one embodiment, the axial length (c-c) is between 5 mm and 30mm. In another embodiment, the axial length (c-c) is between 5 mm and 20mm. In another embodiment, the axial length (c-c) is between 6 mm and 15mm. In a preferred embodiment, the axial length (c-c) is 6 mm. Inanother preferred embodiment, the axial length (c-c) is 10 mm. Inanother preferred embodiment, the axial length (c-c) is 15 mm. In oneembodiment, the lateral wall 40 of the second section 14 is generallycylindrical as seen in FIG. 1, FIG. 9 and FIG. 10. In anotherembodiment, the lateral wall 40 of the second section 14 is generallyconical, tapering between the mating end 36 and the leading end 38 asseen in FIG. 11. In one embodiment, the lateral wall 40 of the secondsection 14 tapers between 0.2 degrees and 15 degrees. In anotherembodiment, the lateral wall 16 tapers between 1 degrees and 5 degrees.In another embodiment, the lateral wall 40 of the second section 14tapers between 1 degrees and 3 degrees.

The mating end 36 of the second section 14 of the device 10 isconfigured to mate with the mating end 18 of the first section 12 of thedevice 10. The mating end 18 of the first section 12 and the mating end36 of the second section 14 can comprise any mating mechanism suitablefor the intended purpose of the device 10 can be used, as will beunderstood by those with skill in the art with respect to thisdisclosure. In one embodiment, the mating end 18 of the first section 12and the mating end 36 of the second section 14 mate by a suitablebiocompatible adhesive, as will be understood by those with skill in theart with respect to this disclosure. In a preferred embodiment, themating mechanism is reversible, allowing an interchange of an alternatefirst section 12 to a specific second section 14 so that the device 10can be reconfigured as needed for contouring to a particular jointsurface, thereby decreasing the number of second sections 14 that needto be stored on site, as will be understood by those with skill in theart with respect to this disclosure. In one embodiment, the mating end18 of the first section 12 and the mating end 36 of the second section14 mate by a reversible twist locking mechanism, as will be understoodby those with skill in the art with respect to this disclosure. Inanother embodiment, the first section 12 and the second section 14 aremade as a unified whole as shown in FIG. 11 and are not separable.

The leading end 38 of the second section 14 of the device 10 isconfigured to place the device 10 into a prepared space made accordingto a method according to the present invention. In one embodiment, theleading end 38 comprises a scalloped edge 42. In another embodiment, theleading end 38 comprises bevels 44. In a preferred embodiment, theleading end 38 comprises both a scalloped edge 42 and bevels 44 as shownparticularly in FIG. 1, FIG. 3, FIG. 5 and FIG. 6.

The lateral wall 40 of the second section 14 of the device 10 extendsbetween the mating end 36 and the leading end 38. The lateral wall 40 ofthe second section 14 comprises threads 46 for anchoring the device 10within the bone. In one embodiment, the lateral wall 40 of the secondsection 14 further comprises a plurality of fenestrations 48 between thethreads 46. In a preferred embodiment, the device 10 further comprises aplurality of fenestrations 50 formed by a confluence of the mating end18 of the first section 12 and the mating end 36 of the second section14. Each fenestration 48, 50 can comprise any shape suitable for theintended purpose of the device 10, as will be understood by those withskill in the art with respect to this disclosure. In a preferredembodiment, each fenestration 48, 50 is oval or round. In oneembodiment, the lateral wall 40 of the second section 14 is textured topromote bony ingrowth after implantation, as will be understood by thosewith skill in the art with respect to this disclosure.

The first section 12 and the second section 14 can comprise any materialsuitable for the intended purpose of the device 10, as will beunderstood by those with skill in the art with respect to thisdisclosure. In one embodiment, the first section 12 comprises a materialselected from the group consisting of a biocompatible plastic, abiocomposite polymer, a metal and a metal alloy. In one embodiment, thefirst section 12 comprises a material selected from the group consistingof carbon fiber, cobalt chrome, nitinol, polycaprolactone (PCL),polyether-ether-ketone (PEEK), tantalum and titanium. In one embodiment,the second section 14 comprises a material selected from the groupconsisting of a biocompatible plastic, a biocomposite polymer, a metaland a metal alloy. In one embodiment, the second section 14 comprises amaterial selected from the group consisting of carbon fiber, cobaltchrome, nitinol, polycaprolactone (PCL), polyether-ether-ketone (PEEK),tantalum and titanium. In one embodiment, the first section 12 comprisesa first material and the second section 14 comprises a second material,where the first material and the second material are the same material.In another embodiment, the first section 12 comprises a first materialand the second section 14 comprises a second material, where the firstmaterial and the second material are the different materials.

In one embodiment, the device 10 further comprises an insert 52.Referring now to FIG. 12, FIG. 13, FIG. 14 and FIG. 15, there are shown,respectively, a top, lateral perspective view of one embodiment of aninsert according to the present invention for use with a device forameliorating joint conditions and diseases according to the presentinvention (FIG. 12); a bottom, lateral perspective view of theembodiment of the insert shown in FIG. 12 (FIG. 13); a top, lateralperspective view of one embodiment of the device for ameliorating jointconditions and diseases shown in FIG. 1 with the insert shown in FIG. 12according to the present invention affixed to the device (FIG. 14); anda cross-sectional view of the device for ameliorating joint conditionsand diseases shown in FIG. 1 with the insert shown in FIG. 12 (FIG. 15).As can be seen, the insert 52 comprises a base 54 and three or more thanthree extensions 56 connected to the base 54 and arranged radiallyaround the base 54. Each of the three or more than three extensions 56is configured to fit within a corresponding fenestration 28 of thejoint-ward end 16 of the first section 12 of the device 10, such thatwhen the insert 52 is mated to the first section 12 of the device 10,the insert 52 occupies each of the three or more than threefenestrations 28 as shown particularly in FIG. 5. The insert 52comprises porous biological material impregnated with matrix-promotingsubstances or serves as a scaffold for progenitor cells, or comprisesboth porous biological material impregnated with matrix-promotingsubstances and serves as a scaffold for progenitor cells.

The device 10 can be made by any suitable method, as will be understoodby those with skill in the art with respect to this disclosure. In oneembodiment, the first section 12 and the second section 14 are machinedfrom modular parts such as by direct metal laser sintering, as will beunderstood by those with skill in the art with respect to thisdisclosure.

According to another embodiment of the present invention, there isprovided a method for ameliorating a joint condition or disease in apatient. Referring now to FIG. 16 through FIG. 35, there are shownschematic depictions of some steps of a method for ameliorating jointconditions and diseases according to the present invention. The Figuresshow the embodiment of the method being used on a femorotibial joint 100to ameliorate an arthritic condition which has caused a defect 102 on anarticulation surface 104 of a bone or joint, shown here as on the medialcondyle 106 of the femur 108.

The method comprises identifying a patient with a joint condition ordisease that is suitable for treatment by the present method, where thejoint comprises a bone with a surface comprising a defect caused by thejoint condition or disease. As will be understood by those with skill inthe art with respect to this disclosure, the joint can be any joint witha hyaline cartilage bearing surface, joint capsule, and synovial fluid.In one embodiment, the joint is a diarthrodial joint (also know as asynovial joint). In one embodiment, the joint is selected from the groupconsisting of an acetabulofemoral joint, an acromioclavicular joint, afemoropatellar joint, a femorotibial joint, a glenohumeral joint, ahumeroradial joint, a humeroulnar joint, an interphalangeal joint, ametacarpal joint, a radioulnar joint and a talocrural joint. In oneembodiment, the patient is a human. In one embodiment, the patient is anon-human animal. In a preferred embodiment, the joint condition anddisease is selected from the group consisting of arthroses,chondromalacia patella, isolated chondral defect, juvenile idiopathicarthritis, ligamentous deficiency arthroses, osteoarthritis(degenerative arthritis or degenerative joint disease), osteonecrosis,osteochondritis dissecans, patellar instability, post-ligamentous injuryarthritis, post-meniscectomy arthritis, post-meniscectomy arthroses,post-traumatic arthritis, rheumatoid arthritis and septic arthritis. Inone embodiment, identifying the patient comprises diagnosing the patientwith a joint condition and disease. In one embodiment, diagnosing thepatient comprises performing one or more than one of action selectedfrom the group consisting of performing a physical examination,performing a non-invasive imaging examination (such as magneticresonance imaging, computerized tomography and ultrasound) andperforming arthroscopy. In another embodiment, identifying the patientcomprises consulting patient records to determine if the patient has ajoint condition or disease suitable for treatment by the present method.

Next, the method further comprises accessing the joint 100. In oneembodiment, accessing the joint 100 is accomplished by arthroscopy. Inanother embodiment, accessing the joint 100 is accomplished by an opensurgical procedure, such as for example a mini-open procedure.

In one embodiment, as shown in FIG. 17 and FIG. 18, the surface 104 ofthe bone comprises an abnormality 110 (such as for example areacartilage softening, thinning, damage, or absence), and the methodfurther comprises using a burr, or a suction shaver, or both a burr anda suction shaver 112 to remove some or all of the abnormalities 110thereby creating a smoother articulation surface 104 as shown in FIG.19.

Then, the method further comprises placing a guidepin 114 within thecenter of the defect 102 as shown in FIG. 20.

Next, the method further comprises creating a space 116 in the defect102 of the bone for a device. In one embodiment, the space 116 iscreated using a bone reamer 118 placed over the guidepin 114 to core andplane the surface of the defect 102 as shown in FIG. 21, FIG. 22 andFIG. 23. The bone reamer 118 is then removed leaving the guidepin 114 inplace.

In one embodiment, the method further comprises creating one or morethan one vascular channel in the bone deep to the space 116 using adrill bit guide 120 positioned over the guidepin 114 and a drill bit 122passed within the drill bit guide 120 as shown in FIG. 23, FIG. 24 andFIG. 25. Confirmation of creation of the one or more than one vascularchannel is made by the presence of blood 124 leaking into the space 116from the one or more than one vascular channel. The drill bit guide 120and drill bit 122 are then removed leaving the guidepin 114 in place.

Next, the method further comprises providing a first device 126 forameliorating joint conditions and diseases suitable for ameliorating thejoint condition or disease of the patient as can be seen in FIG. 26. Inone embodiment, the first device 126 is a device according to thepresent invention. The first device 126 provided has a size suitable forincorporation into the space 116 made in the defect 102, and thejoint-ward end of the first device 126 comprises a shape suitable tosubstantially match the shape of the articulation surface 104 that thefirst device 126 recreates on the bone after implantation, as will beunderstood by those with skill in the art with respect to thisdisclosure. Referring now to FIG. 27, the first device 126 is attachedto a driver 128, such as for example by mating the distal end of thedriver 128 with the central aperture of the first device 126.

In one embodiment, the method further comprises injecting a biologicmaterial, such as for example stem cells or platelet rich plasma, orboth stem cells and platelet rich plasma 130 into the first device 126using an injector 132 as shown in FIG. 28. In one embodiment, the methodfurther comprises placing an insert according to the present inventionin the first device 126 instead of injecting a biocompatible bone cementin the first device 126. In one embodiment, the insert is a biologicalmaterial according to the present invention.

Then, the method further comprises screwing the first device 126 intothe space 116 using the driver 128, as shown in FIG. 29, FIG. 30, FIG.31 and FIG. 32. FIG. 33 is a partial, lateral cross-section of themedial condyle 106 at the site of the defect 102 showing placement ofthe first device 126. As can be seen, the joint-ward end of the firstdevice 126 forms a shape that substantially recreates the shape of anormal articulation surface on the bone after implantation.

In one embodiment, as can be seen in FIG. 26 and FIG. 34, the methodfurther comprises placing one or more than one additional device 134,136 in the defect 102. In one embodiment, the one or more than oneadditional device is one additional device. In another embodiment, oneor more than one additional device is two additional devices. As will beunderstood by those with skill in the art with respect to thisdisclosure, the one or more than one additional device 134, 136 can bethe same as the first device in terms of size and shape or can bedifferent than the first device in terms of size and shape.

Though the method of the present invention has been disclosed withrespect to a defect 102 in a femorotibial joint 100, correspondingmethods can be used with other joints. FIG. 35 is a partial, lateralcross-section of a glenohumeral joint 138 at the site of a defectshowing placement of a device for ameliorating joint conditions anddiseases according to the present invention.

Although the present invention has been discussed in considerable detailwith reference to certain preferred embodiments, other embodiments arepossible. Therefore, the scope of the appended claims should not belimited to the description of preferred embodiments contained in thisdisclosure.

What is claimed is:
 1. A method for ameliorating a joint condition ordisease in a patient, the method comprising: a) identifying a patientwith a joint condition or disease that is suitable for treatment by themethod, where the joint comprises a bone with a surface comprising adefect caused by the joint condition or disease; b) accessing the joint;c) placing a guidepin within the center of the defect; d) creating aspace in the defect of the bone; e) providing a first device forameliorating joint conditions and diseases, the first device comprising:i) a first section comprising a joint-ward end, an opposing mating end,and a lateral wall extending between the joint-ward end and the matingend; where the first section further comprises a peripheral columnpartially forming the lateral wall of the first section, a centralcolumn, and three or more than three struts, each strut extendingbetween and connecting the peripheral column and the central column, andeach strut thereby supporting the central column; where the joint-wardend further comprises a plurality of fenestrations, where eachfenestration is formed by a confluence of the peripheral column, thecentral column and two adjacent struts of the three or more than threestruts; and where the first section further comprises a central aperturewithin and formed by the central column, and configured to mate with anintroducer; and ii) a second section comprising a mating end, anopposing leading end, and a lateral wall extending between the matingend and the leading end; where the lateral wall of the second sectioncomprises threads; where the first device comprises an axial length ofbetween 5 mm and 30 mm; where the first section further comprises adiameter of between 5 mm and 30 mm; where the leading end comprises ascalloped edge and bevels; and where the lateral wall of the secondsection further comprises a plurality of fenestrations between thethreads; f) attaching the first device to a driver by mating a distalend of the driver with the central aperture of the first device; and g)screwing the first device into the space using the driver until thejoint-ward end of the first device forms a shape that substantiallyrecreates a shape of the bone surface at an articulation area afterimplantation.
 2. The method of claim 1, where the joint is selected fromthe group consisting of an acetabulofemoral joint, an acromioclavicularjoint, a femoropatellar joint, a femorotibial joint, a glenohumeraljoint, a humeroradial joint, a humeroulnar joint, an interphalangealjoint, a metacarpal joint, a radioulnar joint and a talocrural joint. 3.The method of claim 1, where the joint condition and disease is selectedfrom the group consisting of arthroses, chondromalacia patella, isolatedchondral defect, juvenile idiopathic arthritis, ligamentous deficiencyarthroses, osteoarthritis, degenerative arthritis, degenerative jointdisease, osteonecrosis, osteochondritis dissecans, patellar instability,post-ligamentous injury arthritis, post-meniscectomy arthritis,post-meniscectomy arthroses, post-traumatic arthritis, rheumatoidarthritis and septic arthritis.
 4. The method of claim 1, whereidentifying the patient comprises diagnosing the patient with a jointcondition and disease by performing one or more than one action selectedfrom the group consisting of performing a physical examination,performing a non-invasive imaging examination and performingarthroscopy.
 5. The method of claim 1, where identifying the patientcomprises consulting patient records to determine if the patient has ajoint condition or disease suitable for treatment by the method.
 6. Themethod of claim 1, where accessing the joint is accomplished byarthroscopy or by an open surgical procedure.
 7. The method of claim 1,where the surface of the bone comprises one or more than oneabnormality, and where the method further comprises using a burr, or asuction shaver, or both a burr and a suction shaver to remove some orall of the one or more than one abnormality thereby creating a smootherarticulation surface.
 8. The method of claim 1, further comprisingcreating one or more than one vascular channel in the bone deep to thespace using a drill bit guide positioned over the guidepin and a drillbit passed within the drill bit guide.
 9. The method of claim 1, furthercomprising injecting a biological material in the first device.
 10. Themethod of claim 1, further comprising placing an insert in the firstdevice.
 11. The method of claim 1, further comprising placing one ormore than one additional device in the defect.
 12. The method of claim1, where the peripheral column comprises one or more than one notch. 13.The method of claim 1, where the lateral wall of the second section isgenerally cylindrical.
 14. The method of claim 1, where the lateral wallof the second section is generally conical, tapering between the matingend and the leading end.